High-Risk Pregnancy

High-risk pregnancy indicates the chances of health-related complications in the mother, baby, or both during pregnancy and childbirth compared to a normal pregnancy.

High-Risk Pregnancy Symptoms

A few common signs and symptoms associated with high-risk pregnancy include:

• Vaginal bleeding
• Continuous abdominal pain
• Pain in chest
• Palpitations
• Severe nausea and vomiting that persists for the whole day
• Swelling and redness of face and limbs
• Decreased baby movement
• Frequent dizziness and fainting
• Fatigue
• Severe headache
• Thoughts of harming yourself and your baby
• Persistent fever

High-Risk Pregnancy Causes

• Maternal Age: Mothers older than 35 years or younger than 17 years are more prone to high-risk pregnancies.
• Lifestyle: Positive history of drinking, smoking, and abusing substances increases the chances of risk in pregnancy.
• Maternal Health Complications: Health complications such as obesity, increased blood pressure, thyroid disease, cardiovascular disease, chronic infections, asthma, and gestational diabetes increase the risk of complications in pregnancy.
• Pregnancy History: Any pregnancy-related complications in previous pregnancies such as preterm delivery or preeclampsia put the current pregnancy at high risk.
• Multiple Pregnancies: Women with twin or triplet pregnancies face higher pregnancy-related risks.
• Complications in Present Pregnancy: Rhesus factor mismatch, restricted fetal growth, and abnormal placenta positioning can lead to high-risk pregnancies.

Typical Tests for High-Risk Pregnancy

As a high-risk pregnancy requires close monitoring, the gynecologist might recommend specific tests for the desired outcome. These tests include:

• Specialized ultrasounds are used for the analysis of fetal development.
• Invasive procedures such as amniocentesis are done after 15 weeks of pregnancy to identify brain and spinal cord development defects.
• Chorionic villus sampling is performed to identify genetic defects in the fetus.
• Healthcare professionals can also suggest ultrasound for assessing cervical length and lab tests for early identification of chronic infections to prevent complications such as preterm labor in high-risk pregnancies.
• A biophysical profile is advised to monitor breathing, amniotic fluid, and fetal movements.

High-Risk Pregnancy Treatment

A high-risk pregnancy requires a specialized care plan according to individual requirements.

• Follow-up with an obstetrician
• Consulting maternal-fetal medicine specialist
• Follow up with medical specialists
• Frequent ultrasounds for closed evaluation of fetal growth
• Treating underlying medical conditions
• Starting folic acid and multivitamins early.

High-Risk Pregnancy Risk Factors

Multiple risk factors that can be associated with high-risk pregnancies are

• Being overweight and underweight before pregnancy: Women with BMI less than 19.8 or more than 29.9 are more prone to develop complications during pregnancy and delivery.
• Complicated previous pregnancies.

Medical conditions occurring during pregnancy are also risk factors. These conditions might be:

• Preeclampsia: With high blood pressure and changes in liver enzymes and urinary proteins during pregnancy, there is an increased risk of damage to the kidney, liver, and brain of the mother.
• Gestational Diabetes: A non-diabetic mother can develop diabetes during pregnancy, which requires early diagnosis and adequate treatment to ensure the safety of the mother and fetus.
• HIV: An HIV-positive mother can transfer the disease to the fetus. This will destroy the immune system of the baby, making HIV a risk factor during pregnancy.
• Kidney and Respiratory Problems: These medical issues can increase the chances of pregnancy-related complications and even threaten the unborn baby’s health.
• Zika Infection: Zika virus infection during or before pregnancy increases the chances of defects in the brain and nervous system in the fetus, stillbirth, and pregnancy loss.

Possible Complications of High-Risk Pregnancy

A high-risk pregnancy can pose life-threatening complications for the mother and an unborn child.

These complications include:

• Preterm Delivery
• High or low birth weight
• Congenital disabilities
• Abnormal brain development of the child
• Requirement of neonatal intensive care unit for the baby after birth
• High blood pressure in the mother during the pregnancy
• Seizures
• C-section
• Excessive bleeding at the time of delivery
• Stillbirth
• Miscarriage

Prevention of High-Risk Pregnancy

Primary and Secondary Prevention of High-Risk Pregnancy

As a high-risk pregnancy is associated with multiple risk factors, some simple steps can prevent the health complications associated with the condition. These include:

• Improved Lifestyle: If you are at risk of developing health-related complications during pregnancy, it is advisable to stop using alcohol and quit smoking or using other harmful drugs.
• Prenatal Consultation: Planning a pregnancy under the supervision of specialized healthcare professionals and continuous monitoring of the mother and fetal health helps prevent complications during and after delivery.
• Prenatal Care: If you have a medical history that can cause a high-risk pregnancy, start prenatal care such as intake of folic acid and multivitamins.

The healthcare professional might adjust the ongoing treatment for a medical condition in preparation for pregnancy.

Epidemiology

• Approximately 30% of total pregnancies are high-risk pregnancies, leading to 3/4th of perinatal mortalities and morbidities in India.
• Adolescent mothers with ages less than 19 years and over 35 years are more prone to high-risk pregnancies. These women are at high risk of infections, endometriosis, and eclampsia during pregnancy.

Prognosis

Expected Prognosis

Some high-risk pregnancies do not cause any health-related complications for the mother and the fetus but can cause long-term complications such as postpartum depression, high blood pressure, cardiovascular disease, and complications during future pregnancies.

Natural Progression

If additional care is not given during high-risk pregnancy, it might lead to developmental defects in the fetus and premature delivery. It may also affect mothers with conditions such as eclampsia and preeclampsia and cause stillbirth or miscarriage.

Pathophysiology

Various pathophysiological changes occurring in the mother and fetus during a high-risk pregnancy threaten the fetus's health. In a high-risk pregnancy, there can be an increase in blood pressure and a change in liver enzymes. These physiological changes can affect the development of the liver, kidney, and brain in a fetus, causing long-term health-related complications. Altered metabolism functioning during pregnancy results in gestational diabetes. Infections from the mother get transferred to the fetus, causing health-related complications.